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"AN OBSCURE INJURY TO THE HIP."
312 MRs. D. 0. HILL’S model for
a
colossal statue of Dr.
THE
ship
A1tld Reelcie arrived at Dundee
on
the 28th
inst.,
Livingstone, of which we gave a description last week, has with a severe case of small-pox on board, and was at once been photographed by Mr. T. A. Hill, of Edinburgh. The placed in quarantine. photograph, which is beautifully executed, preserves the S]EALL-pox has so increased at Santiago that Congress free and flowing lines of the model, and its effective dishas had to vote 100,000 dollars in aid of the movement posal of light and shadow appears to great advantage. The for hospital extension. public are now enabled to have a representation of the -
noble work of art which New York is about to dedicate to
the
missionary explorer.
-
Correspondence.
M. Louis, the distinguished French physician, whose contributions to the diagnosis and treatment of phthisis are known to all the profession, has just died in Paris at the age of eighty-six. He was followed to the grave on the 24th by the élite of the profession. A full account of his life and labours will appear in our next. THE Committee of Management of the Liverpool Royal Infirmary School of Medicine have appealed to the public for further funds towards the completion of the new buildings in connexion with the medical school. We trust that the remaining portion of the required sum will be very soon made up. -
AT
meeting of the Weekly Board of Governors of Cbaring-cross Hospital on the 27th inst., it was resolved a
that the thanks of the Board should be transmitted to the THE LANCET for their contribution of newspapers for the inmates of that institution.
proprietors of
THE Fifth Annual General Meeting of the Association of Certifying Medical Officers of Great Britain and Ireland will be held at the Clifton Down Hotel, Bristol, on Friday, the 13th of September, at 2 P.M., when Dr. Arlidge, the president, will deliver the annual address.
HER MAJESTY’S Consul-General at Christiania has been
,officially informed that vessels from St. Petersburg, Cronstadt, Helsingfurs, Odessa, and Russian harbours in the Black Sea and the Sea of Azof, are to be considered cholera-smitten until further notice.
as
THE most skilled alienists in Europe have expended their the Empress Charlotte in vain. The paroxysmal excitement which used to appear at stated intervals has gone-a symptom which her medical advisers look upon as of the worst augury.
care on
-
M. DORNIGES, a medical practitioner residing at Bourges (Cher), has just died, and bequeathed 100,000 francs for the foundation of a prize, to be competed for annually, for the best essay on a physiologico-moral question. FROM India we learn that "everyone, from the DeputyCommissioner downwards, has had dengue in the Bassein district of British Burmah." THE West Ward Workhouse, Penrith, will be closed, by order of the Local Government Board, on the 29th of
September. IN
-
Buckinghamshire, Cambridgeshire, and Huntingdonare now suffering severely from the foot
shire, the cattle
and mouth disease. ____
AT Carlisle, .8500 out of the Hospital Sunday fund was recently distributed to the various medical institutions in the locality. -
THE Crown Princess of ill at Ostend.
Italy is reported to be dangerously
"Audi alteram
partem."
"AN OBSCURE INJURY TO THE HIP." To the Editor of THE LANCET. accordance with my promise I now forward you SIR,-In accurate account of the case of " Injury to the Hip " recently tried at the Manchester Assizes. In my judgment the case is one of great surgical interest, independently of its connexion with the trial ; and, considering the imperfect nature of the account you have been led into publishing, I feel sure you will be glad to find a place for this communication, if only in justification of the two gentlemen who have been charged with malpraxis in the matter. The plaintiff, on the llth of December last, endeavoured to jump from the platform of a railway station on to a luggage train as it passed. Failing in his attempt, he fell, and, after being severely crushed between the platform and the train, was eventually thrown out upon the line. He was picked up by the servants of the railway company, conveyed to an hotel, and a medical man was sent for. Dr. Maclagan, of Mexborough, was almost immediately on the spot, and was the first surgeon to take charge of the case. Judging from the condition in which he found his patient, and from the nature of the accident as described to him by the railway officials, Dr. Maclagan suspected some serious injury to the pelvis. Acting on this impression he had the patient undressed and placed upon a couch, and, on two separate occasions, each time under the influence of chloroform, he made most careful and minute examination. The results of those examinations, as sworn to by Dr. Maclagan in the witness-box, were shortly these :-Parallelism of the limbs; great muscular crushing and bruising; perfect mobility of both hip-joints; the two limbs of exactly the same length. (In your report Dr. Maclagan’s name is never mentioned, his evidence is altogether ignored, and I am stated to be the surgeon who first saw and examined the case.) That same night the patient, acting on his own responsibility alone, returned home from Mexborough to Manchester. On arriving at home, Mr. Buckley (his usual medical attendant) was sent for, and saw the case without delay. The points sworn to by Mr. Buckley in the witness-box were these :-Perfect parallelism of the limbs; great muscular crushing and bruising; excessive pain on manipulation; the limbs of exactly the same length ; perfect mobility of both limbs ; absence of crepitus. Under these circumstances Mr. Buckley did not use splints ; but, as he felt that the bruised limb needed support, he placed sand-bags on either side of it, and thus attempted to provide support without the pressure that bandages and splints would have caused. From that time forward for several weeks, the patient was kept closely confined to bed, the left bip-joint continuing swollen and painful. Day after day, for many days, Mr. Buckley carefully measured and remeasured the limb. The measurements he swore to making were these: - 1st, from the anterior superior spinous process of the ilium to the upper margin of the great trochanter; 2nd, from the anterior superior spinous process of the i1inm along the inside of the knee to the inner malleolus. (Your report represents Mr. Buckley as not knowing how to measure the limb, and does him decided injustice; his measurements, as sworn to in his evidence, were measurements skilfully and properly made.) A day or two after the accident the measurements thus made showed the injured limb to be a little longer than the sound one. At this point in its history Dr. J. Ogden Fletcher was rean
313 quested
to
see
the
case on
behalf of the
"
Accidental In-
claim on them in consequence of the accident. Dr. Fletcher deposed on oath to the same general conditions as had been sworn to by Dr. Maclagan and Mr. Buckley-viz., the limbs of equal length ; no want of parallelism ; perfect mobility of the joint ; absence of crepitus ; excessive pain and swelling. (Dr. Fletcher’s evidence is altogether ignored in surance
your
Company," the plaintiff having
made
a
report.)
About
five weeks after
the accident Mr. Buckley became uneasy because he noticed, in addition to the unabated continuance of pain, that the left limb was beginning slowly to shorten, and to become slightly inverted. Now, Sir, what ought Mr. Buckley to have done under these circnmstancesHe should have remembered, you say, " that in the multitude of counsellors there is safety." This is exactly what he did, and, fearing lest some absorption might be taking place in the bruised head and neck of the femur, he expressed a desire for further advice. In response to this wish, Dr. Fletcher was again called in, this time in the character of "consultant." Once more the patient was most anxiously examined by these two gentlemen, and, according to their evidence, in all sorts of positions. Their attention was drawn by the patient to the following points : swelling over the hip-joint, continuance of pain, slight inversion, and apparent shortening. Dr. Fletcher considered all these symptoms to be probably the result of the original bruising, and recommended that the part should be freely painted with iodine, and that the limb should be brought into gentle use and exercise. From this time the shortening of the limb steadily progressed ; the patient dismissed Mr. Buckley, fell in with a bone-setter, and finally was seen by the late Mr. Beevor, who on March 4th, 1872, close upon three months after the accident, pronounced the case to be one of "dislocation on to the dorsum ilii." The man afterwards went into the Manchester Infirmary, and was seen by the surgeons of that institution for thefirst time on Jnly 1st, 1872. They unanimously confirmed Mr. Beevor’s opinion, considered it too late to attempt, reduction ; and then it was that the patient beg’an to talk of bringing an action against Mr. Buckley and Dr. Fletcher. On the 19th of July, when the action was about to be tried, Mr. Favell of Sheffield and I were reqtiested by Dr. Fletcher to examine and report upon the case. We made the examination in the presence of Mr. Southam, Mr. Heath, Mr. Bowring, and several other surgeons of We found an undoubted diseminence in Manchester. location of the joint backwards. The head of the femur could be felt behind the acetabulum, resting upon the upper margin of the sciatic notch ; there was an inch and a half of shortening, slight inversion, and unusually free mobility of the part. The patient could plant both feet flat and parallel upon the ground, and could walk tolerably well with the aid of a stick and a high-heeled shoe. On grasping the head of the femur, and pressing it firmly down upon the pelvis, whilst the limb was rotated, I felt and pointed out to many of the others that a distinct sense of grating" was produced. The evidence I gave in the witness-box was this :-1. That the case was not, as it was said to be, a simple and uncomplicated one from the first of dislocation on to the dorsum ilii. 2. That the lengthening of the limb, observed during the first few days, was incompatible with such a view of the case. 3. That the accident was in its nature
blnnder from the first; and, accepting their account as a reliable one, I came to the conclusi)n that there must have been, in the first instance, a fractured acetahulum, and that the dislocation had been a secondary occurrence. The jury returned a verdict, I regret to say, for the plaintiff; but, at the same time, they marked their sense of the obscurity and difficulty of the case by only awarding damages of forty shillings (not pounds, as is stated in your
report).
I am, Sir, your obedient serva.nt, C. G. WHEELHOUSE. WHEEL-HOUSE. Hillary-place, Leeds, August 23rd, 1872.
GUARANA. of THE LANCET.
To the Editor
SIR,-The great interest your journal has always evinced in every matter connected with the medical profession, and its strict impartiality in discussing all questions that appear on the scientific horizon, embolden me to believe that you will favourably receive the communication 1 now have the honour to address to you. It relates to guarana, and has been suggested by the article which appeared in THE LANCET of the 15th of June last. I venture to hope that it will interest your readers, as containing accurate informa tion respecting the seeds of the Paullinia sorilis, mainly derived from a paper by Dr. Wiesner, recently published in the Ausland. The first mention of guarana is found in a work by Martius, entitled "Travels in Brazil" (vol. iii., pp. 1061-
1098).
Two kinds of guarana are to be found in the European one being pure and well prepared, the other either adulterated or most imperfectly manufactured. For this product to possess its proper virtues, the seed must be used while quite fresh, otherwise fermentation ensues and greatly deteriorates the quality. It must also be made up without any mixture of cacao or tapioca (Silva Consinho’s "Remarks on Guarana," Rio de Janeiro, 1866). The different manipulations to which the Manhés subject the paullinia seed sufficiently explain how the fraud in question may be practised. The seed, after being slightly roasted, is reduced to powder, and then mixed with water and made into a stiff paste. With this paste a certain proportion of whole and broken seeds is blended ; then the mass is moulded into cylindrical rolls, and in this state is ready for the market. I have now before me the cases published by Dr. Wilks to which THE LANCET alludes. In one he declares that the giiarana "acted like a charm"; in another, of which he himself was the subject, that he obtained a doubtful result; in a third he quotes a letter from Dr. Wood, of Montreal, who cured himself of sick headache with the guarana powders. 11 By taking one of these powders," says Dr. Wood, "when I felt premonitory symptoms, I have carried off the attack, and with the first box absolutely put it off for " two months, a thing which had never occurred in my life before." Dr. Wilks earnestly advises his professional brethren to try this medicine, at the same time stating that it is prepared by Grimault, of No. 7, Rue de la Feuillade, Paris. These cases, you will perceive, are altogether favourable to guarana, and I feel myself justified, as well by my own such an one as was exceedingly likely to produce deep-seated experience as by that of many physicians of my acquaintinjury, and probably did produce great ligamentous dis- ance, in affirming that this medicine never fails, except ruption and fracture through the acetabulum. 4. That so when improperly prepared, adulterated, or injudiciously long as the patient was kept recumbent, and the muscles administered. were paralysed by crushing, the parts all held together; The following is our process for preparing the powders but that, on commencing to move about, and with returning mentioned by Dr. Wilks :-The rolls of guarana are first muscular power, they slowly gave way. 5. That the case pulverised, and then treated with alcohol; the liquor is was not, as it was said to have been, a simple and uncomthen brought to the consistence of an extract, dried, and plicated one of dislocation on to the dorsum iJii from the powdered. Our product consequently contains in a small first. 6. That Mr. Buckley had not been guilty of negli- volume all the active properties of the seed, and is quite gence, and that he had not treated the case either unsurgi- free from adulteration. Administered in doses of two or four grammes, to be cally or unskilfully. As neither the Manchester surgeons nor I had seen the taken at twice, with an interval of two hours (in case of case until it was eight months old, I did not feel that we non-success), these powders are a certain remedy for the were at liberty to ignore the history of the earlier symptoms sick-headache. of the case; and I declined to believe that Dr. Macla.gan, Guarana owes its curative virtues to the great quantity Mr. Buckley, and Dr. Fletcher had all three committed a of caffein which it contains. Trommdorf makes the pro-
markets,
a
colossal statue of Dr.
THE
ship
A1tld Reelcie arrived at Dundee
on
the 28th
inst.,
Livingstone, of which we gave a description last week, has with a severe case of small-pox on board, and was at once been photographed by Mr. T. A. Hill, of Edinburgh. The placed in quarantine. photograph, which is beautifully executed, preserves the S]EALL-pox has so increased at Santiago that Congress free and flowing lines of the model, and its effective dishas had to vote 100,000 dollars in aid of the movement posal of light and shadow appears to great advantage. The for hospital extension. public are now enabled to have a representation of the -
noble work of art which New York is about to dedicate to
the
missionary explorer.
-
Correspondence.
M. Louis, the distinguished French physician, whose contributions to the diagnosis and treatment of phthisis are known to all the profession, has just died in Paris at the age of eighty-six. He was followed to the grave on the 24th by the élite of the profession. A full account of his life and labours will appear in our next. THE Committee of Management of the Liverpool Royal Infirmary School of Medicine have appealed to the public for further funds towards the completion of the new buildings in connexion with the medical school. We trust that the remaining portion of the required sum will be very soon made up. -
AT
meeting of the Weekly Board of Governors of Cbaring-cross Hospital on the 27th inst., it was resolved a
that the thanks of the Board should be transmitted to the THE LANCET for their contribution of newspapers for the inmates of that institution.
proprietors of
THE Fifth Annual General Meeting of the Association of Certifying Medical Officers of Great Britain and Ireland will be held at the Clifton Down Hotel, Bristol, on Friday, the 13th of September, at 2 P.M., when Dr. Arlidge, the president, will deliver the annual address.
HER MAJESTY’S Consul-General at Christiania has been
,officially informed that vessels from St. Petersburg, Cronstadt, Helsingfurs, Odessa, and Russian harbours in the Black Sea and the Sea of Azof, are to be considered cholera-smitten until further notice.
as
THE most skilled alienists in Europe have expended their the Empress Charlotte in vain. The paroxysmal excitement which used to appear at stated intervals has gone-a symptom which her medical advisers look upon as of the worst augury.
care on
-
M. DORNIGES, a medical practitioner residing at Bourges (Cher), has just died, and bequeathed 100,000 francs for the foundation of a prize, to be competed for annually, for the best essay on a physiologico-moral question. FROM India we learn that "everyone, from the DeputyCommissioner downwards, has had dengue in the Bassein district of British Burmah." THE West Ward Workhouse, Penrith, will be closed, by order of the Local Government Board, on the 29th of
September. IN
-
Buckinghamshire, Cambridgeshire, and Huntingdonare now suffering severely from the foot
shire, the cattle
and mouth disease. ____
AT Carlisle, .8500 out of the Hospital Sunday fund was recently distributed to the various medical institutions in the locality. -
THE Crown Princess of ill at Ostend.
Italy is reported to be dangerously
"Audi alteram
partem."
"AN OBSCURE INJURY TO THE HIP." To the Editor of THE LANCET. accordance with my promise I now forward you SIR,-In accurate account of the case of " Injury to the Hip " recently tried at the Manchester Assizes. In my judgment the case is one of great surgical interest, independently of its connexion with the trial ; and, considering the imperfect nature of the account you have been led into publishing, I feel sure you will be glad to find a place for this communication, if only in justification of the two gentlemen who have been charged with malpraxis in the matter. The plaintiff, on the llth of December last, endeavoured to jump from the platform of a railway station on to a luggage train as it passed. Failing in his attempt, he fell, and, after being severely crushed between the platform and the train, was eventually thrown out upon the line. He was picked up by the servants of the railway company, conveyed to an hotel, and a medical man was sent for. Dr. Maclagan, of Mexborough, was almost immediately on the spot, and was the first surgeon to take charge of the case. Judging from the condition in which he found his patient, and from the nature of the accident as described to him by the railway officials, Dr. Maclagan suspected some serious injury to the pelvis. Acting on this impression he had the patient undressed and placed upon a couch, and, on two separate occasions, each time under the influence of chloroform, he made most careful and minute examination. The results of those examinations, as sworn to by Dr. Maclagan in the witness-box, were shortly these :-Parallelism of the limbs; great muscular crushing and bruising; perfect mobility of both hip-joints; the two limbs of exactly the same length. (In your report Dr. Maclagan’s name is never mentioned, his evidence is altogether ignored, and I am stated to be the surgeon who first saw and examined the case.) That same night the patient, acting on his own responsibility alone, returned home from Mexborough to Manchester. On arriving at home, Mr. Buckley (his usual medical attendant) was sent for, and saw the case without delay. The points sworn to by Mr. Buckley in the witness-box were these :-Perfect parallelism of the limbs; great muscular crushing and bruising; excessive pain on manipulation; the limbs of exactly the same length ; perfect mobility of both limbs ; absence of crepitus. Under these circumstances Mr. Buckley did not use splints ; but, as he felt that the bruised limb needed support, he placed sand-bags on either side of it, and thus attempted to provide support without the pressure that bandages and splints would have caused. From that time forward for several weeks, the patient was kept closely confined to bed, the left bip-joint continuing swollen and painful. Day after day, for many days, Mr. Buckley carefully measured and remeasured the limb. The measurements he swore to making were these: - 1st, from the anterior superior spinous process of the ilium to the upper margin of the great trochanter; 2nd, from the anterior superior spinous process of the i1inm along the inside of the knee to the inner malleolus. (Your report represents Mr. Buckley as not knowing how to measure the limb, and does him decided injustice; his measurements, as sworn to in his evidence, were measurements skilfully and properly made.) A day or two after the accident the measurements thus made showed the injured limb to be a little longer than the sound one. At this point in its history Dr. J. Ogden Fletcher was rean
313 quested
to
see
the
case on
behalf of the
"
Accidental In-
claim on them in consequence of the accident. Dr. Fletcher deposed on oath to the same general conditions as had been sworn to by Dr. Maclagan and Mr. Buckley-viz., the limbs of equal length ; no want of parallelism ; perfect mobility of the joint ; absence of crepitus ; excessive pain and swelling. (Dr. Fletcher’s evidence is altogether ignored in surance
your
Company," the plaintiff having
made
a
report.)
About
five weeks after
the accident Mr. Buckley became uneasy because he noticed, in addition to the unabated continuance of pain, that the left limb was beginning slowly to shorten, and to become slightly inverted. Now, Sir, what ought Mr. Buckley to have done under these circnmstancesHe should have remembered, you say, " that in the multitude of counsellors there is safety." This is exactly what he did, and, fearing lest some absorption might be taking place in the bruised head and neck of the femur, he expressed a desire for further advice. In response to this wish, Dr. Fletcher was again called in, this time in the character of "consultant." Once more the patient was most anxiously examined by these two gentlemen, and, according to their evidence, in all sorts of positions. Their attention was drawn by the patient to the following points : swelling over the hip-joint, continuance of pain, slight inversion, and apparent shortening. Dr. Fletcher considered all these symptoms to be probably the result of the original bruising, and recommended that the part should be freely painted with iodine, and that the limb should be brought into gentle use and exercise. From this time the shortening of the limb steadily progressed ; the patient dismissed Mr. Buckley, fell in with a bone-setter, and finally was seen by the late Mr. Beevor, who on March 4th, 1872, close upon three months after the accident, pronounced the case to be one of "dislocation on to the dorsum ilii." The man afterwards went into the Manchester Infirmary, and was seen by the surgeons of that institution for thefirst time on Jnly 1st, 1872. They unanimously confirmed Mr. Beevor’s opinion, considered it too late to attempt, reduction ; and then it was that the patient beg’an to talk of bringing an action against Mr. Buckley and Dr. Fletcher. On the 19th of July, when the action was about to be tried, Mr. Favell of Sheffield and I were reqtiested by Dr. Fletcher to examine and report upon the case. We made the examination in the presence of Mr. Southam, Mr. Heath, Mr. Bowring, and several other surgeons of We found an undoubted diseminence in Manchester. location of the joint backwards. The head of the femur could be felt behind the acetabulum, resting upon the upper margin of the sciatic notch ; there was an inch and a half of shortening, slight inversion, and unusually free mobility of the part. The patient could plant both feet flat and parallel upon the ground, and could walk tolerably well with the aid of a stick and a high-heeled shoe. On grasping the head of the femur, and pressing it firmly down upon the pelvis, whilst the limb was rotated, I felt and pointed out to many of the others that a distinct sense of grating" was produced. The evidence I gave in the witness-box was this :-1. That the case was not, as it was said to be, a simple and uncomplicated one from the first of dislocation on to the dorsum ilii. 2. That the lengthening of the limb, observed during the first few days, was incompatible with such a view of the case. 3. That the accident was in its nature
blnnder from the first; and, accepting their account as a reliable one, I came to the conclusi)n that there must have been, in the first instance, a fractured acetahulum, and that the dislocation had been a secondary occurrence. The jury returned a verdict, I regret to say, for the plaintiff; but, at the same time, they marked their sense of the obscurity and difficulty of the case by only awarding damages of forty shillings (not pounds, as is stated in your
report).
I am, Sir, your obedient serva.nt, C. G. WHEELHOUSE. WHEEL-HOUSE. Hillary-place, Leeds, August 23rd, 1872.
GUARANA. of THE LANCET.
To the Editor
SIR,-The great interest your journal has always evinced in every matter connected with the medical profession, and its strict impartiality in discussing all questions that appear on the scientific horizon, embolden me to believe that you will favourably receive the communication 1 now have the honour to address to you. It relates to guarana, and has been suggested by the article which appeared in THE LANCET of the 15th of June last. I venture to hope that it will interest your readers, as containing accurate informa tion respecting the seeds of the Paullinia sorilis, mainly derived from a paper by Dr. Wiesner, recently published in the Ausland. The first mention of guarana is found in a work by Martius, entitled "Travels in Brazil" (vol. iii., pp. 1061-
1098).
Two kinds of guarana are to be found in the European one being pure and well prepared, the other either adulterated or most imperfectly manufactured. For this product to possess its proper virtues, the seed must be used while quite fresh, otherwise fermentation ensues and greatly deteriorates the quality. It must also be made up without any mixture of cacao or tapioca (Silva Consinho’s "Remarks on Guarana," Rio de Janeiro, 1866). The different manipulations to which the Manhés subject the paullinia seed sufficiently explain how the fraud in question may be practised. The seed, after being slightly roasted, is reduced to powder, and then mixed with water and made into a stiff paste. With this paste a certain proportion of whole and broken seeds is blended ; then the mass is moulded into cylindrical rolls, and in this state is ready for the market. I have now before me the cases published by Dr. Wilks to which THE LANCET alludes. In one he declares that the giiarana "acted like a charm"; in another, of which he himself was the subject, that he obtained a doubtful result; in a third he quotes a letter from Dr. Wood, of Montreal, who cured himself of sick headache with the guarana powders. 11 By taking one of these powders," says Dr. Wood, "when I felt premonitory symptoms, I have carried off the attack, and with the first box absolutely put it off for " two months, a thing which had never occurred in my life before." Dr. Wilks earnestly advises his professional brethren to try this medicine, at the same time stating that it is prepared by Grimault, of No. 7, Rue de la Feuillade, Paris. These cases, you will perceive, are altogether favourable to guarana, and I feel myself justified, as well by my own such an one as was exceedingly likely to produce deep-seated experience as by that of many physicians of my acquaintinjury, and probably did produce great ligamentous dis- ance, in affirming that this medicine never fails, except ruption and fracture through the acetabulum. 4. That so when improperly prepared, adulterated, or injudiciously long as the patient was kept recumbent, and the muscles administered. were paralysed by crushing, the parts all held together; The following is our process for preparing the powders but that, on commencing to move about, and with returning mentioned by Dr. Wilks :-The rolls of guarana are first muscular power, they slowly gave way. 5. That the case pulverised, and then treated with alcohol; the liquor is was not, as it was said to have been, a simple and uncomthen brought to the consistence of an extract, dried, and plicated one of dislocation on to the dorsum iJii from the powdered. Our product consequently contains in a small first. 6. That Mr. Buckley had not been guilty of negli- volume all the active properties of the seed, and is quite gence, and that he had not treated the case either unsurgi- free from adulteration. Administered in doses of two or four grammes, to be cally or unskilfully. As neither the Manchester surgeons nor I had seen the taken at twice, with an interval of two hours (in case of case until it was eight months old, I did not feel that we non-success), these powders are a certain remedy for the were at liberty to ignore the history of the earlier symptoms sick-headache. of the case; and I declined to believe that Dr. Macla.gan, Guarana owes its curative virtues to the great quantity Mr. Buckley, and Dr. Fletcher had all three committed a of caffein which it contains. Trommdorf makes the pro-
markets,